Parallel Practice

I honestly do not know what is going to happen to NHS General Practice in the UK. What is even more worrying is that neither do my colleagues, both high and low, ivory tower or coal face, working or retired.

The Royal College of General Practitioners and BMA are calling for more money for primary care, or at least a greater slice of the NHS budget cake. These are tired and tested demands that have had negligible impact on patient needs in the past. The government's counter proposal is to pluck 5000 new GPs from some nebulous pie in the sky.

In the meantime fewer medical graduates are entering into post-graduate specialist training in general practice whilst simultaneously more middle aged GPs are retiring early for a whole medley of reasons amongst which is the insatiable demand for their services. The combination of these factors is leading to difficulties recruiting GP partners resulting in undermanned practices having to close down thus putting even more pressure on those practices that manage to remain open five days a week, let alone the proposed seven proposed by an upbeat but frankly delusionary Prime Minister.

This disintegration of a cornerstone of healthcare in this country will have a huge impact on each and every one of us. Yet no-one seems to have put these facts to the public and asked what they feel. What actually do we want from our family doctor service?

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Patient surveys, such as they are, repeatedly raise the same desires, which can be summarised as 'quick and easy access to the doctor of my choice'. This simple but forlorn hope has been constant since the inception of the NHS so perhaps after 65 years we should finally lay it to rest. Or maybe we can make it a reality by tweaking it slightly and removing the 'of my choice' element. Can the demographics of a changing profession be matched society's aspirations?

GPs fall in to two major groupings. They are either the traditional GP Principal (or Partner), responsible for their patient list and all aspects of running a GP surgery; or, and in increasing numbers, Salaried or Sessional GPs, full or part-time employees with more limited responsibilities mainly centred on patient clinical care. The former tend to have been in practice for a long time and know their patients well; the latter tend to limit their involvement to the immediate medical concerns of the patient consulting them at that time. This is naturally a generalisation and many duties overlap but perhaps the answer to our conundrum lies in defining and separating these roles further?

First we have to accept that general practice remains a career choice for many young doctors. They just do not want to do it as intensely as their predecessors. They like the flexibility offered by a salaried role. Established GPs also love their job. They just get disillusioned and frustrated when, due to demand from all sides, they cannot do it to the high standard that they would wish. Can these concerns be addressed?

A simple but not simplistic solution may lie in encouraging salaried GPs to focus exclusively on acute cases; that is those patients who feel a need to see a doctor at short notice, and leave those with chronic, long-term problems to be managed by the diminishing pool of GP Principals? This would be no more than an acceptance and acceleration of what is currently happening anyway. Even more simply, we could broadly demarcate by age. Under 60? Door to the right. Over 60? Door to the left.

GPs can cope. It's just that they can't cope with everything. Perhaps if we could more clearly delineate the boundaries of what is expected from them then they would be happier and less likely to prematurely burn out. The profession and we as patients need to accept that in future there will be two parallel lines of care; one dealing with the acute and likely to be ever more based near to hospitals; the other dealing with the elderly and chronic problems and continuing to be based in the community.

The current model of primary care has changed little since the 1950's. Patients have long let it be known what they want from their GP. Perhaps by adopting these minor changes we might go some way towards facilitating their utopian dream of 'quick and easy access to a doctor' without further compromising the provision of what is becoming an increasingly delicate medical service.